Provider Demographics
NPI:1427714419
Name:MACKRETH, WILLIAM JAMES (MICP)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:MACKRETH
Suffix:
Gender:M
Credentials:MICP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 873405
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-3405
Mailing Address - Country:US
Mailing Address - Phone:907-355-0311
Mailing Address - Fax:
Practice Address - Street 1:5630 B ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1641
Practice Address - Country:US
Practice Address - Phone:907-441-8559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-13
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKMEDM179146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic